ABO/UNOS ID Verification Form Organ(s)

ABO/UNOS ID Verification Form
Organ(s):
Heart Liver________
Heart-Lung_______
Liver________
Split Liver________
Lung(s) ________
Right________ Left________ Both ________
Kidney(s) ________
Pancreas________
Other________
Small Bowel________
UNOS Donor ID___________________________
OPO____________________________________
Recovery Team___________________________
Transplant MD____________________________
ABO: _______Recipient ABO/Rh________ Donor ABO/Rh________
Donor Serologies: HIV___ HCV___ HBsAg____ HBcAb___ CMV IgM___ T. Cruzi Ab___EBV IgM___
Verified by___________________________ Date__________________ Time ______________
Verified by___________________________ Date__________________ Time ______________
The donor and recipient ABOs must be verified for compatibility or planned incompatibility prior to organ recovery. 2 team members,
or 1 team member and 1 OPO representative, must sign/date/time prior to organ recovery.
ORGAN RECEIPT AT
UNOS ID Number:_____________________
ABO Compatibility: Recipient ABO/Rh__________________ Donor ABO/Rh______________________
________Recipient and donor are ABO identical - OK to proceed
________Recipient and donor are ABO compatible - OK to proceed
Group A recipients can receive Group A or Group O organs.
Group B recipients can receive Group B or Group O organs.
Group AB recipients can receive Group AB, A, B, or O organs.
________Recipient and donor are ABO incompatible - CAUTION
Verified by___________________________ Date__________________ Time ______________
Verified by___________________________ Date__________________ Time ______________
Verification of UNOS ID and donor/recipient ABO is required prior to organ implantation. The transplanting surgeon (attending or
fellow) and one other licensed team member must sign/date/time prior to organ implantation. If the transplanting surgeon is already
scrubbed in, he/she must verify the UNOS ID and ABOs with the circulator, who can date/time on behalf of the surgeon. The surgeon
can then sign upon completion of the transplant. If the organ(s) has been recovered by another center the “organ recovery team”
please leave the signatures in the top portion of the form blank.

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